Pubdate: Fri, 28 Dec 2012
Source: Wall Street Journal (US)
Copyright: 2012 Dow Jones & Company, Inc.
Contact:  http://www.wsj.com/
Details: http://www.mapinc.org/media/487
Author: Arian Campo-Flores

PAIN PILLS' LITTLEST VICTIMS

Mothers On Oxycodone Give Birth To Drug-Dependent Babies; 'It's
Heartbreaking

SARASOTA, Fla.: Hospitals around the country are confronting an
unsettling consequence of the prescription-pain-pill epidemic: a surge
in the number of babies born dependent on drugs such as oxycodone.

One recent morning a 12-day-old girl lay writhing in the neonatal
intensive-care unit at Sarasota Memorial Hospital. Erin Weatherwax, a
nurse, tried to console the newborn by holding her against her chest
and patting the baby's back. She placed the girl in a motorized swing
that made cricket sounds. But the infant continued to squirm, unable
to sleep more than a few minutes at a time.

The baby suffered withdrawal from methadone, a drug used to treat
painkiller addiction that her mother took during pregnancy. The
hospital sated the baby's physical cravings by giving her morphine as
well as phenobarbital, a barbiturate used to treat seizures. Now she
had to be weaned off those drugs.

"It's heartbreaking," Ms. Weatherwax said.

Between 2000 and 2009, the number of newborns showing symptoms of
withdrawal from drugs called opioids""including painkillers like
oxycodone and antiaddiction drugs such as methadone""tripled in the
U.S., according to a study published earlier this year in the Journal
of the American Medical Association.

In 2009, more than 13,000 babies in the U.S. were diagnosed with the
condition, formally known as neonatal abstinence syndrome, the study
said.

The newborns reminiscent of the "crack babies" of the 1980s and
1990s born to women addicted to cocaine""present a host of challenges
to hospitals. There is no standard way to treat their withdrawal, so
doctors and nurses are improvising to figure out the most effective
combination of drugs and dosages.

The babies require constant attention, and their stays in a neonatal
intensive care unit, or NICU, can stretch for weeks, tying up hospital
resources. Their treatment is costly a mean of $53,400 according
to the JAMA study, and Medicaid covers the tab for 78% of the babies.
Hospital charges to care for such infants jumped to an estimated $720
million in 2009 from $190 million in 2000, the study said.

Hospitals in states such as Kentucky and West Virginia have reported a
sharp rise in the number of opioid-dependent babies. In Florida, long
the nation's epicenter of illegal prescription-drug sales, the problem
is acute, especially in a cluster of counties near Tampa Bay,
including Sarasota. Hospitals such as Spring Hill Regional Hospital,
north of Tampa, said that as many as 30% of the babies in their NICUs
suffer from opioid withdrawal.

Hospitals were ill-prepared for the drug-dependent infants. "This
isn't a problem I learned about in training," said Terri Ashmeade,
medical director of the NICU and chief of pediatrics at Tampa General
Hospital. Her unit, like others, relied at first on protocols for
heroin withdrawal in babies, mainly using phenobarbital, she said. But
the staff quickly found that withdrawal symptoms for today's
painkillers, which are powerful and long-acting, were much more severe.

The newborns cry incessantly, jerk their limbs and vomit. They can
have such severe diarrhea that it burns the skin off their bottoms.
Though treating them with the very opioids they are withdrawing from
may seem jarring, doctors say the alternative could be worse: seizures
and even death.

After years of trying different treatments, Tampa General settled on a
uniform approach three months ago. Like many hospitals, it relies on a
system that assigns points for different symptoms, and it initiates
drug treatment if the numbers cross a certain threshold. (There is no
blood test or other diagnostic to determine whether a baby is
drug-dependent.)

Eight hours after he was born, Gabriel, a baby undergoing treatment
recently at Tampa General's NICU, exhibited a variety of symptoms,
including stiffened muscles and excessive sucking. So the hospital
gave him methadone and, when the symptoms persisted, increased the
doses until he reached the maximum. Two days later, he was still
scoring high, so the hospital gave him clonidine, a drug used to treat
withdrawal in adults.

At eight days, Gabriel was still taking the maximum dosage of
methadone and close to the maximum of clonidine. He appeared mostly
calm, but startled and trembled at times. It would likely take weeks
more to wean him off the drugs, nurses said.

Sixty miles to the south, Sarasota Memorial is following a different
protocol. While using the same scoring system, it starts babies on
morphine, and if necessary, adds phenobarbital.

Hospitals have no choice but to experiment, given the paucity of
research on what treatments are most effective. The American Academy
of Pediatrics in February published new guidelines for neonatal
abstinence syndrome ts first update since 1998. Though the paper
cited a range of potential treatments, it didn't recommend one
particular protocol.

To try to come up with a standard regimen, a collaborative of Florida
hospitals, including Sarasota Memorial, plans to compare various
approaches. Each NICU will rely on morphine and clonidine, but at
different dosages, increased and decreased at different rates, said
Mark Hudak, a neonatologist at Wolfson Children's Hospital in
Jacksonville, which is part of the group. The group hopes to assemble
its findings some time next year.

One objective is to cut down the amount of time babies are spending in
intensive care and assess whether they are being overmedicated, Mr.
Hudak said.

Hospitals are grappling with another concern: They worry they aren't
catching all the affected babies. Not every mother is forthcoming
about using prescription painkillers, which leaves it up to medical
staff to look out for symptoms. Most newborns are discharged within 48
to 72 hours, yet babies exposed to long-acting opioids like methadone
can take five or more days to show signs of withdrawal.

"Some are going home and withdrawing," said Tony Napolitano, medical
director at Sarasota Memorial. And a mother with dependency issues may
not be equipped to handle a highly irritable and sensitive newborn, he
said.

Organizations like the Healthy Start Coalition of Hillsborough County,
a nonprofit, are urging obstetricians to broach the subject of opioid
use with their patients. Many don't, often because they are unaware
how widespread the problem is, said Executive Director Jane Murphy.

Because the phenomenon of opioid-exposed babies is so new, little is
known about any long-term effects. Some studies suggest they are at
greater risk of attention deficit hyperactivity disorder, but the
findings aren't conclusive.

Fears that the "crack babies" of decades past would develop severe
physical, mental and emotional disabilities proved to be unfounded,
research showed. But prescription-drug exposure "seems to be affecting
babies' physiologies more than cocaine," said Ms. Ashmeade, the Tampa
General neonatologist.
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